Healthcare Provider Details

I. General information

NPI: 1972979060
Provider Name (Legal Business Name): MARIA G CERVANTES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 ALBANY SHAKER RD
LOUDONVILLE NY
12211-2136
US

IV. Provider business mailing address

PO BOX 1322
LATHAM NY
12110-8822
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-3739
  • Fax:
Mailing address:
  • Phone: 518-489-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number525638
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number525638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: